Rate of continued conservative management versus progression to surgery at minimum one year follow‐up in patients with pre‐arthritic hip pain

Category: Midfoot/Forefoot Introduction/Purpose: Morton’s neuroma is a common condition affecting the foot and is associated with chronic pain and disability. Conservative management including a combination of orthotic input; injection or physiotherapy, and surgical excision are current treatment options. There is a paucity of literature regarding patient related outcome measures (PROMs) data in patients managed conservatively. We sought to compare conservative with surgical management of Morton’s neuroma using PROMs data in patients with follow-up to one year. Methods: Prospective data collection commenced from April 2016. Patients included had to have a confirmed Morton’s neuroma on ultrasound scan. Patient demographics including age, sex and BMI were collected. The primary outcome measures were the Manchester Foot Score for pain (MOX-FQ), EQ time trade off (TTO) and EQ visual analogue scale (VAS) taken pre-operatively; at 26-weeks and at 52-weeks post-operatively. Results: 194 patients were included overall: 79 patients were conservatively managed and 115 surgically managed. 19 patients were converted from conservative to surgical management. MOX-FQ pain scores: pre-op conservative 52.15, surgical 61.56 (p=0.009), 6-months conservative 25.1, surgical 25.39 (p=0.810), 12 months conservative 18.54, surgical 20.52 (p=0.482) EQ-TTO scores: pre-op conservative 0.47, surgical 0.51 (p=0.814), 6-months conservative 0.41, surgical 0.49 (p=0.261), 12 months conservative 0.26, surgical 0.37 (p=0.047) EQ-VAS scores: pre-op conservative 63.84, surgical 71.03 (p=0.172), 6-months conservative 46.10, surgical 52.51 (p=0.337), 12 months conservative 30.77, surgical 37.58 (p=0.227) Satisfaction at 12 months: conservative 17 (21.5%), surgical 32 (27.8%) p=0.327 Conclusion: This is one of the first studies investigating long-term PROMs specifically in conservative management for Morton’s neuroma patients. There was no significant difference in pain score and EQ-VAS between all conservative treatments and surgical management at 12 months There was no significant difference in satisfaction at 12 months between conservative and surgical groups.

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Traumatic Obturator Hip Dislocation with Marginal Femoral Head Fracture in a 15-Year-Old Adolescent: A High-Energy Trauma—A Case Report and a Review of the Literature

Case Reports in Orthopedics ◽

10.1155/2018/7268032 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Yoann Durand ◽

Clémence Bruyère ◽

Marco Saglini ◽

Aurélien Michel-Traverso

Keyword(s):

Femoral Head ◽

Hip Dislocation ◽

High Energy ◽

Hip Pain ◽

X Rays ◽

Hip Function ◽

One Year ◽

High Level ◽

Joint Limitation

We report the case of a 15-year-old boy brought to the emergency department after a bike accident, complaining of an isolated left hip pain. The X-rays showed an obturator hip dislocation treated by closed reduction under general anaesthesia, followed by 6 weeks of discharge. The follow-up MRI performed 6 weeks after the trauma showed an avascular femoral head necrosis, for which we performed multiple retrograde femoral head drilling, completed by the injection of autologue stem cells from the iliaq crest. One year later, the patient has no hip pain, no joint limitation, and can practice BMX at a high level again. The purpose of this report is to make the physicians aware of this rare problem that may be damaging for hip function, especially in young people.

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PP - ONE YEAR FOLLOW-UP OF CONSERVATIVE MANAGEMENT OF STAGE 3 BISPHOSPHONATE-RELATED OSTEONECROSIS OF THE JAW (BRONJ)

Oral Surgery Oral Medicine Oral Pathology and Oral Radiology ◽

10.1016/j.oooo.2016.09.075 ◽

2017 ◽

Vol 123 (2) ◽

pp. e48

Author(s):

ROGÉRIO JARDIM CALDAS ◽

CÁSSIA MARIA FISCHER RUBIRA ◽

PAULO SÉRGIO DA SILVA SANTOS

Keyword(s):

Conservative Management ◽

Osteonecrosis Of The Jaw ◽

One Year

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Multidisciplinary Approach in a Child with Complex Trauma of Maxillary Permanent Central Incisors

Journal of Dental and Maxillofacial Surgery ◽

10.18314/jdms.v2i1.1778 ◽

2019 ◽

pp. 147-154

Author(s):

Lucisano MP ◽

Corrêa Leite RGL ◽

Nelson-Filho P ◽

Minto AMP ◽

Ferraz JAB ◽

...

Keyword(s):

Case Report ◽

Conservative Management ◽

Multidisciplinary Approach ◽

Complex Trauma ◽

Central Incisor ◽

Present Case Report ◽

Root Fracture ◽

Crown Root ◽

One Year

The present case report describes a multidisciplinary approach involving endodontic, restorative, surgical and periodontal treatment and rehabilitation of a central incisor with crown-root fracture (CRF) in an 11-year-old child. Although in the future possible sequelae and complications should be considered since it is an extensive trauma, the prognosis of the present case is favorable, with the occurrence of repair, evidenced by clinical, radiographic and tomographic success, after one year and six months of follow-up. It was concluded that the association of prolonged flexible splint, biological endodontic treatment, gingivoplasty and restorative/rehabilitative procedures seem to be an adequate and conservative management for CRF cases.

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Conservative Management of Anal Fissures

JMS SKIMS ◽

10.33883/jms.v12i1.10 ◽

2009 ◽

Vol 12 (1) ◽

pp. 11-13

Author(s):

Ajaz A Malik ◽

Shams Ul Bari ◽

Khursheed Alam Wani ◽

Nisar A Chowdri ◽

Sameer A Naqash ◽

...

Keyword(s):

Glyceryl Trinitrate ◽

Conservative Management ◽

Medical Science ◽

Young Population ◽

Anal Fissures ◽

Manual Dilatation ◽

Topical Glyceryl Trinitrate ◽

Considerable Morbidity ◽

One Year

Background: Anal fissures are common, but most are short lived and heal spontaneously. Those which persist and require intervention cause considerable morbidity in an otherwise healthy young population. Glyceryl trinitrate is well in the conservative management of anal fissures. Material and Methods: The retrospective study was carried at Sher-i-Kashmir Institute of Medical Science Srinagar, Kashmir, India from Jan. 2005 to Dec. 2005. Total of 111 patients were studied, to evaluate the result of glyceryl trinitrate treatment in the management of anal fissures. Results: 80% of the fissures healed with topical glyceryl trinitrate treatment over a period of 6-8 weeks, with no recurrence during a one year follow up. The remaining 20% patients had to be managed with manual dilatation (8 patients) and lateral internal sphincterotomy (14 patients). Conclusion: Our conclusion is that glyceryl trinitrate induces a chemical sphincterortomy and produces healing of fissure in majority of patients. J Med Sci 2009;12(1):11-13.

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Aseptic femur head necrosis revealing Cushing's disease: a rare presentation

Journal of Clinical Surgery and Research ◽

10.31579/2768-2757/002 ◽

2020 ◽

Vol 1 (1) ◽

pp. 01-04

Author(s):

Zeineb Alaya

Keyword(s):

Pituitary Adenoma ◽

Cushing’S Disease ◽

Histopathological Examination ◽

Hip Pain ◽

Cushing's Disease ◽

Rare Presentation ◽

Case Presentation ◽

Disease Case ◽

One Year

Background: Cushing's disease is an endocrine disorder and may be associated with non-traumatic osteonecrosis of the hip. We report the case of avascular necrosis of the femoral heads (AVNFH) as the presenting manifestation of Cushing's disease. Case presentation: A 29-year-old male patient was referred to our department because of non-traumatic bilateral hip pain evolving for two years. The pain was associated with lameness when walking. He noticed a drop in libido since one year with erectile dysfunction. Physical examination revealed facio-truncal obesity, abdominal violaceous striae, dorsal hyper-kyphosis, a pain and limitation of internal rotation of the left hip with a Lequesne index of 16. The standard radiography showed a loss of sphericity of the left femoral head with an aspect of eggshell. The MRI confirmed the diagnosis of a bilateral AVNFH. The baseline cortisol level was 287 ng/ml. AVNFH as the presenting manifestation of Cushing's disease was suspected and confirmed by a pituitary MRI which revealed a pituitary adenoma. A discharge of the hips was indicated. The patient underwent surgical resection of the adenoma and was referred to the endocrinology department. The histopathological examination confirmed the diagnosis of pituitary adenoma (corticotrope adenoma). The patient has also received an intravenous perfusion of 5 mg of Zoledronic acid. The follow up was marked by the regression of the symptoms of Cushing's disease and the hip pain. Conclusion: AVNFH as the presenting manifestation of Cushing's disease is rarely described. Hence, it’s needed to exclude endogenous hypercorticism in any patient with idiopathic osteonecrosis.

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